Healthcare Provider Details

I. General information

NPI: 1407353162
Provider Name (Legal Business Name): LAURA ELIZABETH MOYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 RICHMOND RD STE 203
TROY VA
22974-4421
US

IV. Provider business mailing address

2285 ROSE HILL CHURCH LN
CHARLOTTESVILLE VA
22902-7588
US

V. Phone/Fax

Practice location:
  • Phone: 304-777-9384
  • Fax:
Mailing address:
  • Phone: 304-777-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010366
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: